How a PCP Used Remote Patient Monitoring for Patient Relationships

Lifestyle Medical, a Southern California-based primary care practice which had built a range of digital tools into their patient care process

This was originally published in PatientEngagementHIT.

For the leaders at California-based primary care practice Lifestyle Medical, a remote patient monitoring and engagement program looks a lot like having a bi-coastal family.

“Our goal is really around building relationships with patients,” Arwin Soetanto, CEO at Lifestyle Medical, told PatientEngagementHIT. “We thought that the best model for that relationship is a family that lives far away from you.”

When you live on the East Coast and your parents live out west, you might see them three or four times a year for a deep and meaningful visit. This is the same for patients and providers. A clinician might see her chronic care populations three or four times a year to check in on different metrics and deliver some health coaching.

But for both the bi-coastal family and patient-provider relationship, that’s not really enough.

“You have this opportunity to see your family maybe three, four, or five times a year, but you need to have this powerful connection with them,” Soetanto said. “We needed to have this powerful connection with our patients, too. We have the ability to do video and phone visits and communicate with them via messages. Which is powerful, but ineffective for that human connection.”

Long distance families have the benefit of new online tools, like Facebook and Instagram, that help maintain those connections with their loved ones. An adult child might see her parents spend their anniversary at a fancy restaurant, and can have a FaceTime visit to catch up on that evening’s celebrations.

“And that's a much richer experience than just the one-on-one interaction,” Soetanto said. “And we just thought, ‘wow, wouldn't that be great to have this contextual, rich, connection with our patients?’”

After all, it’s those richer connections that tend to keep the sickest patients well. Experts agree a high-touch patient engagement strategy is best for checking on patient wellness measures and delivering health coaching when necessary.

Maintaining a close relationship with patients can allow both patients and providers to recognize when something irregular has arisen with a chronic illness and intervene early and before symptoms become too severe — and costly.

Soetanto and his team at Lifestyle Medical worked to establish this same type of engagement strategy, primarily by using remote patient monitoring systems. Those technologies would act like the Facebook or Instagram that keeps bi-coastal families connected between longer, more meaningful visits.

Using technology from Carium, Soetanto and his team set up a system that allowed patients to collect their own health metrics through various remote tools like Bluetooth blood pressure cuffs or glucometers.

That patient-generated health data integrates into a patient- and provider-facing app, and lets both parties look at and understand patient health at a particular point in time.

According to Soetanto, the tool’s success is rooted in its ability to drive patient activation.

“It wasn't just about getting data from the patient to us. The tool has been really thoughtful around how to design the app in a way that drives patients to be empowered to manage themselves,” Soetanto noted.

“The predominant mindset in healthcare is that healthcare providers are there to manage patients. However, we think people don't need to be managed, they need to be empowered so that they can manage themselves,” he asserted.

The patient-facing side of the app has been essential because it allows patients to understand what drives their health and what can positively impact their wellness. Clinicians at Lifestyle Medicine have leaned on an experiential learning process with the app to drive more meaningful and long-lasting behavior change.

“Humans in general learn better by experience than by being told what to do,” Soetanto pointed out.

For example, a medical provider could tell a patient she can reduce her blood sugar if she takes a walk after dinner. That might be effective, Soetanto concedes.

However, providers at Lifestyle Medical have used a different approach more assured to be effective. One might prompt a patient to check blood sugar after dinner one night without any type of intervention. The next night, the provider may give the same instructions while also encouraging the patient to go for a walk.

That empowers the patient to observe the effect of that lifestyle change — the after-dinner walk — on her own and report back to her provider.

“And that is just a much more powerful way of learning and acquiring new knowledge,” Soetanto said.

Of course, there are some challenges to setting up this tech-enabled system. Many of the patients Lifestyle Medical sees are older, which can pose some digital health literacy problems.

“It’s still an uphill challenge. There's some truth to the general perception that older people don't use technology, and there is no silver bullet,” Soetanto explained.

“We have a series of things we do to ease the burden of using technology, starting with the onboarding,” he added. “We bring our patients in for an in-person onboarding. It's about a half an hour. One of our team members would sit down with the patient and show them how to navigate around their phone. And that just reduces the scariness of it.”

A team-based and collaborative approach for that onboarding team has been crucial, Soetanto noted. Instead of working in siloes, Lifestyle Medical’s technology onboarding team have pooled their lessons learned so they can proactively quell some patient fears when introducing the remote monitoring technologies.

For example, the four-person onboarding team began to notice that patients can get confused when a screen goes dark, which usually automatically happens after a smartphone has been left untouched for 30 seconds.

Onboarding staffers shared this knowledge with one another, suggesting they explain that 30-second feature to patients or even go into the phone and adjust that automated setting.

Like other healthcare organizations across the country, the team at Lifestyle Medical saw a difference in patient use after the COVID-19 pandemic. Soetanto and colleagues had built a remote patient monitoring system that had the potential to overhaul chronic disease management, but until March it had limited uptake.

“Culturally people weren't really that interested, but, overnight, through COVID all of a sudden it was much easier to generate interest,” Soetanto reported.

“The general perception of how uncomfortable it is to see a doctor on video has really changed,” he continued. “We were expecting to, on average, to see patients in the office two or three times a year and doing another two or three video visits.”

The COVID-19 outbreak has made that a bit more of a reality.

Soetanto and his team are still working to make the remote patient monitoring technology more of a reality. Additionally, they are considering work to encourage more video telehealth visits, which Soetanto said might be more meaningful than phone calls, although phone calls are better than no visit at all.

Nevertheless, Soetanto said this system has been a boon for the practice, and will likely remain so as patients continue to demand digital health access in the wake of the pandemic.

“Again, we have a slow adoption time, and we're looking at the people that were the early adopters,” Soetanto concluded. “We thought that this was going to be helpful from the clinical perspective, but we didn't really know. It was a bit of a question mark. So we've been really, really pleased with how much of an impact that the technology has.”